Domain 10. Life principles
Class 3. Value-belief-action congruence
Diagnostic Code: 00066
Nanda label: Spiritual distress
Diagnostic focus: Spiritual distress
Nursing diagnoses are central to the practice of nursing and vital to the health and safety of those in our care. Understanding spiritual distress, a form of psychological stress, is fundamental to providing the best possible care. It is a distressing state of being that occurs when one’s sense of connection to the universe, a higher power, or something greater, has been challenged or is threatened, leading to disruption or loss of comfort, peace, and harmony. By understanding the NANDA International definition of Spiritual Distress, along with related factors and associated conditions, nurses can properly identify and assess the spiritual distress of their patients.
NANDA Nursing Diagnosis Definition
The NANDA-International (NANDA) defines spiritual distress as “a state in which one’s sense of relationship to the sacred or transcendent has been frayed; that is, inner resources and connection to the divine, higher power or beliefs about life and death have been compromised and/or challenged.” The defining characteristics of spiritual distress include subjective indicators such as feelings of disconnection and despair, strangeness or confusion in relation to one’s current circumstance, persistent unease or lack of trust in the divine, negative self-talk, and denial of faith. Objective indicators may include refraining from religious practices or rituals, diminished participation in personal growth activities, and avoidance of personal integration discussions.
There are several related factors that might contribute to spiritual distress. One relates to an individual’s “cognitive schemas,” or definitions of self in regard to personal values and beliefs. This can be influenced by past experiences, current circumstances, or relationships. Difficult life events may also lead to spiritual distress, such as loss of a loved one or appropriate support systems, physical illness or injury, financial hardship or job loss, or moral dilemmas. Finally, symptoms of mental or physical illness can affect one’s ability to access or maintain belief systems or spiritual practices.
At Risk Population
Certain populations are at risk for developing spiritual distress. Age is often a factor, as many people go through spiritual transitions in the years following high school or college graduation. As life circumstances change, individuals may struggle with redefining core beliefs or higher purpose. Those who have limited support structures, including those without family or without close friends of the same faith, may also be more likely to experience spiritual distress. Additionally, those with chronic or terminal illnesses, who may experience multiple losses over time, may be particularly vulnerable to disruptions in spiritual well-being.
Having spiritual distress can exacerbate existing health problems or lead to new ones. Generally, this occurs when spiritual needs are unmet or neglected, leading to feelings of abandonment or further disconnection from the divine. Anxiety and depression, both mental health conditions, are frequently associated with spiritual distress. Physical conditions such as fatigue, headaches, appetite changes, insomnia, GI disturbances, and altered immune functioning might also be experienced by those with spiritual distress.
Suggestions for Use
Nurses should consider spiritual distress an essential element of health care assessment and treatment. Nurses may use history taking, interview and observation methods to assess for spiritual distress in their patients. Defining characteristics and interventions can provide the nurse with guidance in determining the presence, degree and nature of the problem.
Suggested Alternative NANDA Nursing Diagnoses
In addition to spiritual distress, NANDA offers alternative diagnoses that may better address a patient’s identity and experience. These diagnoses include self-care deficit due to spiritual and emotional overload, spiritual conflict, and generalized spiritual awareness crises. Each diagnosis has its own defining characteristics and related factors, to help patients recognize and understand their own experiences and needs.
Because of the varied cultural, religious and spiritual backgrounds of healthcare consumers, it is important for nurses to be aware of and consider any differences when assessing for spiritual distress. Nurses should respect the values and beliefs of their patients and use words that are specific to each particular person’s faith and culture. Finally, it is beneficial for nurses to work in collaboration with other healthcare providers, such as therapists, counselors and chaplains, to ensure that all aspects of the person’s spiritual care are addressed.
NOC Outcomes are measurable long-term goals developed to aid in assessing nursing interventions for patients with spiritual distress. These outcomes include Spiritual Well-Being, Coping, Comfort Level, and Meaning in Life. Spiritual Well-Being measures an individual’s overall spiritual health, while Coping describes one’s ability to manage life stressors in a healthy way. Comfort Level gauges both physical and emotional relaxation, emotional stability and security, and self-care habits. Meaning in Life measures how a patient’s values, beliefs, and purpose in life can contribute to his or her health and wellbeing.
Evaluation Objectives and Criteria
Various evaluation objectives can be used to monitor an individual’s progress. These objectives should be tailored to the specific issues presented by a patient. Evaluation criteria should be based on evidence-based practice, and based on both subjective and objective indicators. Examples of evaluation objectives include: an increase in spiritual wellness, improved coping skills, improved relaxation and comfort level, and heightened meaning in life.
NIC interventions are strategies nurses can use to address a patient’s spiritual distress. Examples of these interventions include facilitating growth and wellness, providing supportive counseling, assisting with moral decision making, and offering spiritual/existential reflections. Facilitating growth and wellness refers to creating an environment that is conducive to the individual’s spiritual growth. Supportive counseling involves providing emotional comfort, encouraging examination of spiritual beliefs, and validating the patient’s feelings. Assisting with moral decision-making involves helping the patient evaluate and make decisions consistent with his or her religious and spiritual beliefs. Finally, spiritual/existential reflections focus on helping the patient find meaning in life and reconnect with his or her inner resources.
Nurses can provide a variety of interventions to help manage spiritual distress. Along with administering NIC Interventions, nurses may also refer patients to appropriate resources within their community, such as religious and spiritual leaders, support groups, and mental health counselors. Educating the patient on self-care techniques and providing referrals to pastoral services are helpful interventions. Nurses can also assist the patient and their families in finding resolution to ethical dilemmas, if applicable.
Nurses play a critical role in recognizing spiritual distress and providing interventions that promote health and healing. With an understanding of the NANDA Nursing Diagnosis Definition and related factors, along with assessment and evaluation objectives, nurses can ensure that spiritual needs are adequately met. In addition, nurses can use the list of suggested NIC interventions to help alleviate the effects of spiritual distress.
- What is spiritual distress? Spiritual distress is a state of discomfort caused by a disruption of the sense of connection to the divine, higher power, or something greater, leading to a lack of peace or harmony. It can often be characterized by feeling disconnected, confused, and overwhelmed.
- What are some associated conditions of spiritual distress? Mental and physical health conditions can be associated with spiritual distress. These can include anxiety, depression, fatigue, headaches, appetite changes, insomnia, GI disturbances, and altered immune functioning.
- How can nurses assess for spiritual distress? Nurses can use history taking, interview and observation methods to assess for spiritual distress in their patients. Defining characteristics and interventions can provide nurses with guidance in determining the presence, degree and nature of the problem.
- What interventions can nurses employ? Nurses can intervene in various ways to help address spiritual distress. These can include facilitating growth and wellness, providing supportive counseling, assisting with moral decision making, offering spiritual/existential reflections, referring to appropriate resources, educating on self-care techniques and providing referrals to pastoral services.
- Are there any long-term goals for assessing spiritual distress? Yes, NOC Outcomes are long-term goals developed to aid in assessing nursing interventions for patients suffering from spiritual distress. These include Spiritual Well-Being, Coping, Comfort Level, and Meaning in Life.